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I -T ' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _607 ....... ............................. Permit No. 7......-- (Complete in Triplicate) ........... ............ This Permit Expires i Year from Bate Issued Date lssued ...._............... Application is hereby mode to the San Joaquin Local Health District for a permit to construct rand install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...... .. ..5p__._•_•./ r -........ -D T ----CENSUS TRACT .................. f�R..1 D...._...... !7_eO�l-A- Phone . .s? " ._.'�--r�.�..__._ Owner's Name 6 Address ................. �7�'i��' ......------ ••-- ................. ----------- ----------- Cit -•--........... ............................... Contractor's Name . ------------------------------------- -----License # ,.c'5�. 8�.... Phoner31`.'I !Y�t�. Installation will serve:-- Residence-®-Apartment House,❑•Commercial ❑Troiler•Court-C--'----F I *)IV4 ,: Motel ❑ Other ............... Number of living units:_. r I- .. Numbe f bedrooms....Garbage Grinder .......,_ LatTSiZe, . ..z `:'.__...... . Water Supply: Public System and name ._ ---• ]..__.Private ❑ ----------• :��- -------------- . Character of soil to a depth of 3 feet: Sand'❑ Silt❑ \Clay--❑" Pea❑ Sandy Loam E] Clay Loam � �S , . Hardpan ❑ Adobe ❑ Fill Material- " --. If yes, type .......... .... ........... (Plot pian, showing size of lot,,,locotion_.,of system in,"relation to wells,huildings,Metc. must be placed on reverse side.) i NEW INSTALLATION: (No septic6nk or eses epage ,pit pe rr+1 d off public:sewer is avaiiab(e within 200'feet,) i .TREATMENT [ ] SEPTIC TANK I J Size X_�:.?C_-- --- �"..7.""Liquid�Depth ��-_...... .. PACKAGE TREAT � Capacity ,.f,�0--0_.....ITypel (��f' Material.,..-..ounda'tiona.�o � CompP o �eLine ___�._.�_.... OQg 1 i Distance to nearest: Well p . Alj LEACHING LINE r J No, of iLine,s Length of each line....h dt �S....... Total Length, v�?r t.... ! � D' Box, ._.��. .. - Type IFihn � ............................•_ er Material .�.h�X.��_Depth Filter 'Material � __.:. I Distance to' nearest: Well ..� , ---- Foundation ts,d--......_....-. Property Line ] ._... _. SEEPAGE PIT [ ] Depth ? % _ Diameter ................. Number ....... Rock Filled Yes ❑ No ❑ IF. .. : �..�...___..._. k , Water Table Dep#h t ------------- ----•-•--•---Roc size s Distance to nearest: Well ---.----- -..... ........Foundation ......__.... ..._... Prop] Line -------_... ...... REPAIR/ADDITION lPrev. Sanitation Permit# -------- ___------. - ti pate ................ .................) ; Septic Tank (Specify Requirements) ... ... .... ................... ..__. .. ....... .............. -- ------ —:,...._..,..-•----....3------- Disposal Field (Specify Requirements) --•--- --. .... ................ .....� . ; r r ] t.4 - ---- --------------- -- ------------ -- .�. f ................. ..................... . ;::.--�------ --- ---•---..._....-- ---.-. ... ....... -' (Dra'w existing and required &—dditlon on-reverse--side) I hereby certify that 1 have prepared this application and that the work will be done in accordance. with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. H;me owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work"Far wW h this permit mit is issued, I shall not employ',any person in such manner as to become sub'ect to ark an's Compensation laws of California." Signed .:.._.'_ Owner F . wner i Y ) ..-- -- . .Title . ... 1 . ..._..... , (If other than owner) s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED I3Y .... .. ........ ....... ..... .. ......_....... DATE :;.... r1 -•-----•--•-•--- BUILDING-PERMIT ISSUED C`-_...................,... � ADDITIONAL_ COMMENTS ....... .. ...... --- - : ♦ - - _.,. --• --------------- . .............. ..................... --- Final inspection by: ... .............. ._ Date . ... -..f.`.�.�� -- ---•------• SAN JOAQUIN LOCAL HEALTH DISTRICT ..-E. H. L3 241-'d8 Rev. 5M 7/72 3 M